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Pharmacology > Diabetes & Thyroid Drugs > Flashcards

Diabetes & Thyroid Drugs Flashcards

1
Q

Rapid-acting: Lispro Insulin (onset, peak, duration)

A

Onset: 15-30 min
Peak: 0.5-3 hr
Duration: 3-5 hr

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2
Q

Short-acting: Regular Insulin (onset, peak, duration)

A

Onset: 30min -1 hr
Peak: 1-5 hr
Duration: 6-10 hr

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3
Q

Intermediate-acting: NPH (onset, peak, duration)

A

Onset: 1-2 hr
Peak: 4-14 hr
Duration: 14-24 hr

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4
Q

Long acting: Glargine, Detemir (onset, peak, duration)

A

Onset: 1-4 hr
Peak: none
Duration: 24 hr

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5
Q

Insulin Therapeutic Use

A

Glycemic control of diabetes mellitus (type 1, type 2, gestational)
Clients with type 2 diabetes can require insulin when:
- oral anti diabetic meds, diet, and exercise or unable to control blood glucose levels.
-severe renal or liver disease is present
-painful neuropathy is present
-undergoing emergency treatment of diabetes keto acidosis (DKA) and hyperosmolar hyperglycemia nonketotic syndrome
-Requiring treatment of hyperkalemia

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6
Q

Insulin Adverse Effects

A

Hypoglycemia (blood glucose < 70 mg/dL)
Hypokalemia
Lipohypertrophy

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7
Q

Manifestations of Hypoglycemia

A

-headaches, disorientation, lethargy
-tachycardia, palpitations
-diaphoresis, shakiness (tremors)

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8
Q

Manifestations of hypokalemia

A

-Confusion, lethargy
-shallow breathing, dysrhythmia
-N/V, weakness

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9
Q

Insulin Interactions

A

Alcohol and beta blockers add additive effect
Thiazide diuretics and glucocorticoids increase blood glucose thereby counteracting effect
Beta blockers can mask symptoms of hypoglycemia

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10
Q

Pharmacological action:
Sulfonylureas (chlorpropamide, glipizide)

A

Insulin release from the pancreas; can increase tissue sensitivity to insulin over time

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11
Q

Pharmacological action: Biguanides (Metformin)

A

Reduces the production of glucose within the liver through suppression of gluconeogenesis
Increases glucose uptake and use in fat and skeletal muscles
Decrease glucose absorption in the GI tracts
First choice medication for most clients who have type 2 diabetes

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12
Q

Pharmacological action: Thiazolidinediones (Pioglitazone)

A

Increases cellular response to insulin by decreasing insulin resistance
Increases glucose uptake and decreased glucose production

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13
Q

Pharmacological Action: Alpha-glucosidase inhibitors (Acarbose)

A

Slows carbohydrate absorption and digestion
Miglitol was particularly effective for clients of Latino or African heritage in clinical trials

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14
Q

Pharmacological action: Dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins)

A

Augments naturally occurring in retain hormones, which promote release of insulin and decrease secretion of glucagon
Lowers fasting and postprandial blood glucose levels

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15
Q

Glipizide adverse effect

A

Hypoglycemia
Weight gain

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16
Q

Metformin adverse effects

A

Gastrointestinal effects (anorexia, nausea, and diarrhea- weight loss)
Vitamin B12 and folic acid deficiency
Lactic acidosis (myalgia, malaise, somnolence, and hyperventilation)
May cause metallic taste

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17
Q

Pioglitazone adverse effects

A

Fluid retention
Elevations in LDL cholesterol
Hepatotoxicity
Ovulation in females who had been anovulatory (perimenopausal)

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18
Q

Acarbose adverse effects

A

GI effects (abdominal distensión and cramping, hyperactive bowel sounds, diarrhea, excessive gas)
Anemia due to the decrease of iron absorption
Hepatotoxicity with long-term use
Impaired breakdown of sucrose

19
Q

Sitagliptin adverse effect

A

Can cause pancreatitis (rare)

20
Q

Oral anti diabetic drug Precautions/contraindications

A

Caution in clients with heart and renal failure, liver dysfunction, or are pregnant

21
Q

Metformin contraindication/precaution

A

Clients who have severe infection, shock, kidney impairment, and any hypoxic condition
Should not be used by someone with alcohol use disorder

22
Q

Acarbose Precaution/Contraindication

A

Clients who have GI disorders (inflammatory disease, ulceration, or obstruction)

23
Q

Pioglitazone precautions/contraindication

A

Clients who have severe heart failure, history of bladder cancer and active hepatic disease
Use caution in those with mild heart failure

24
Q

Sitagliptin precautions/contraindication

A

Upper respiratory tract infection
Should only be used in pregnancy if clearly indicated

25
Glipizide Drug interactions
NSAIDs or beta blockers —> Additive hypoglycemic effect
26
Metformin Drug interactions
Alcohol or cimetidine —> lactic acidosis
27
Pioglitazone drug interactions
Insulin —> fluid retention
28
Nursing Implications on antidibetic drug
Assess client before administration -ability to consume food -nausea or vomiting (can be a sign of low blood sugar) -diet status —if NPO, clarify order for anti diabetic drug therapy Assess blood glucose levels before drug administration -insulin requirement may increase due to stress, infection, illness or trauma, pregnancy, or lactation
29
Administration
Subcutaneous injection sites Needle, gauge, syringe selection Mixing and drawing up insulin Timing of insulin dose with meals
30
Nursing implications
Give oral anti diabetics 30 min before meals - Give Metformin with meals Discontinue Metformin if client is to undergo studies with contrast dye Assess for hypoglycemia - if present, give glucose elevating drugs Monitor therapeutic response -Blood glucose levels, HbA1C -Manifestations of hypoglycemia or hyperglycemia
31
Levothyroxine action
Synthetic form of thyroxin (T4), liothyronin (T3) and combo of T3 and T4 - increase metabolic rate and protein synthesis -increase cardiac output and renal perfusion (blood flow through kidney) -increase body temperature -oxygen use -blood volume and growth processes
32
Manifestations of hypothyroidism
Drowsiness, lethargy, confusion Bradycardia Anorexia, weight gain, edema Constipation Fatigue, weakness Intolerance to cold Dry, sparse coarse hair Depression
33
Levothyroxine Adverse effects
Thyroid storm (when thyroid levels are too high) - Tachycardia, palpitations, chest pain - increased blood pressure - Anxiety, nervousness, tremors, insomnia - Weight loss - heat intolerance Long term use of medication - osteoporosis
34
Levothyroxine Contraindications
Caution in clients with hypertension Caution in clients with diabetes Not for use in the treatment of obesity Contraindicated for clients who have thyrotoxicosis and adrenal insufficiency
35
Levothyroxine Interactions
Decrease effectiveness of insulin Increases excretion of digoxin Increases effects of warfarin Food decreases absorption of Levothyroxine ( take an hour before breakfast) Antacids, iron, and calcium supplements reduce absorption therefore levothyroxine should not be taken within 4 hours of these medications
36
Levothyroxine nursing implications
Obtain baseline vital signs monitor for tachycardia and irregular pulse (check apical pulse) Daily therapy begins with a low dose that increases gradually over several weeks (full effect of medication can take 6-8 weeks) Monitor T4 and TSH levels Medication is dosed in micrograms
37
Client teaching Levothyroxine
Notify provider if heart palpitations, chest pain, or symptoms of thyroid store are present. Do not discontinue. Therapy is lifelong Notify provider before switching to to another brand. Dosage adjustments Take medication on empty stomach 30 -60 min before breakfast
38
On the test
Metformin Levothyroxine Thyroxine Acarbose : when should they take Know peaks for medication ex. Insulin Lab values what they are related to Hemogloblin A1C Know lab values for blood sugar fasting When someone is hypoglycemic we can give them juice (higher intake of protein and lower intake of carbohydrates) Metoprolol - diabetes action If pt is awake and blood sugar is low … give oral medication first then IV Thyrotoxicosis - one question on exam Glucose elevating drugs : management of hypoglycemic reaction - oral concentrated glucose -intravenous dextrose in water (D5W) -Dextrose 50% (D50) -Glucagon —- subcut, IM, IV Question on hyperglycemia and what are you gonna do Know what food to eat with hypothyroidism (focus on weight gain, edema, constipation) : Grains, leafy greens Avoid foods in high in iodine because of the medications (PTU or methimazole) <— these are given with Give PO with Insulin Oral anti diabetic drugs you take the pill with the food Insulin is given to pt with hyperglycemia —- take food within the onset of action Hypoglycemia- does not have to be taken with food (their blood sugar is low) PTU is safe for pregnancy
39
Can levothyroxine be crushed ?
Yes, levothyroxine can be crushed because it is not extended-release, sublingual, or enteric-coated. If crushed the medication should be mixed with 5 to 10 mL of water.
40
Propylthiouracil for client who is pregnant
This medication is used to treat hyperthyroidism during the first trimester or pregnancy bc it does not cross the placental barrier well. Methimazole is the preferred medication in the second and third trimesters of pregnancy.
41
Levothyroxine Administration
Give orally to treat hypoglycemia and IV to treat myxedema coma Give daily on an empty stomach (30-60 min) before breakfast with a full glass of water Monitor for cardiac excitability Expect lifelong replacement therapy Instruct client to notify provider if medication has changed its brand to a different levothyroxine product Food reduces its absorption
42
A nurse is teaching a client who has hyperthyroidism about managing this disorder.
Increase caloric intake with meals Explanation: clients whose thyroid hormone levels are high have increase protein, lipid, and carbohydrate metabolism resulting in loss of protein stores. Meeting energy demands is difficult and weight loss is common.
43
Interactions with oral antidiabetic drugs
Sulfonyureas (glipizide, glyouride), Thiazolidinediones (pioglitazone), and metformin, can all be taken together Acarbose, can be taken with sulfonyureas and metformin Sulfonylureas should not be taken with insulin Sitagliptin, should not be taken with insulin due to hypoglycemic effect

Pharmacology (5 decks)

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